12.8. International initiatives

The role of the European Union on the international health scene has become more visible in recent years, as a consequence of the development of the EU health competences. With the exception of communicable diseases and development aid, the primary focus of EU health policy is the protection and promotion of the health of citizens living within the European Union. Article 152 of the treaty provides that 'the Community and the Member States shall foster co-operation with third countries and the competent international organisations in the sphere of public health’.

Given the complex scientific and technical issues to be addressed, international health initiatives can only succeed if based on concrete health activities within the EU. Furthermore, such initiatives must respect the limited competences given to the European Union in the public health field. Since many aspects remain a national or even a regional competence, the EU negotiations with Third Parties or international organizations must combine national prerogatives with those stemming from Community law. At the same time, individual Member States can no longer enter international agreements without respecting the common discipline of EU prerogatives.

The chief international negotiator is always the Commission, but it is for the Council to conclude new international agreements, in consultation with Parliament. Once such an agreement is reached, the Commission is in charge of implementation and co-ordination with the countries and international organizations concerned, involving where relevant the expertise of EU agencies. There are numerous bilateral contacts between the Commission, EU agencies and health authorities around the world, for example the US Food and Drug Administration (FDA) and the US Center for Disease Control (CDC) or their counterparts in Canada and other countries.

The enlargement process

Also the latest enlargements of the EU from 15 to 27 member States (Table 12.10) started in the health sector as an international exercise, followed by a progressive integration of representatives and experts from the candidate countries in the European mechanisms, meetings and conferences. Special missions were organised in each country as well as visitor programmes using specific EU external programmes (TACIS and TAIEX) and also the Public Health programme when it started in 2003. This integration was facilitated by an excellent level of collaboration between the Commission services, EFTA countries, the Council of Europe and the WHO Regional Office for Europe. Croatia and Turkey started negotiations in 2005. The Former Yugoslav Republic of Macedonia was granted status as a candidate country in December 2005.

Table 12.10. The 27 European Union Member States and accession date.

The Treaty of Rome, establishing the Economic European Community, was approved in the year 1957.

Enlargement in the health sector has been a challenging process for all those involved – the Member States, the Commission, and, most of all, the countries themselves that had to undertake enormous efforts to fulfil all the requirements that a future member state has to meet. The enlargement has brought together a diverse group of countries with considerable variations in the health status measured in terms of the basic health indicators, such as life expectancy and infant mortality. It also meant taking on board a significant body of legislation which has a direct impact on health in areas such as qualifications for health professionals, free movement of health-related goods and services, and the environment.

The Commission took a number of initiatives to help candidate countries meet the accession-related health requirements over the past years. Owing to the nature of the accession process and the Community competence on health, much of the work had to focus on helping the candidates to take on the public health “acquis”.

Even before accession, all candidate countries were directly associated to the Public Health Programme through specific memoranda of understanding, so that specific actions on health in the applicant countries could be launched, including assessing the impact of the enlargement process on health. Turkey and Croatia are directly associated to the EU Public Health Programme.

The existing Public Health Programme has limited means, less than 60 million euro per year but the new Member States can use the EU Structural Funds for regional health investment in a broad sense. This opens wide opportunities for health improvement.

The European Economic Area

Since 1992, the European Community has had a special co-operation with Iceland, Norway and Liechtenstein, who, together with the European Community Member States form the so-called European Economic Area. Protocol 31 to this EEA Agreement describes the co-operation in a number of fields. Article 16 of that Protocol deals with co-operation in the field of Public Health. This enabled these countries to participate in the eight public health Community action programmes that ran until the end of 2002. All countries fully accept to take on board EU legislation on health and pharmaceuticals.

In practice, all parties are closely involved and provide their expertise during the preparation of all EU measures. They are furthermore able to participate in the Network for the epidemiological surveillance and control of communicable diseases in the Community Their experts and representatives take part and play an important role in the EU agencies, such as the European medicines Agency in London and the European Centre for disease prevention and control in Stockholm.

Representatives from the 3 EFTA countries and from the European Commission services meet regularly to agree on joint policies and actions in the health sector. EFTA countries participate fully in the current European Community Public Health Programme and in all decision-making by the programme committee. EFTA countries participated in close to one third of all projects selected in 2005. The EEA and Norway’s Financial Mechanism plays a complementary role in supporting health investment in particular in the Eastern European countries. The EU Structural Funds, together with the EEA and the Norwegian Financial mechanisms, can help bridge the health gap across Europe.